Written Language Practice, Self-Efficacy, and Beliefs: A Survey of Speech-Language Pathologists Working With School-Aged Clients.

PURPOSE: This study examined the clinical practice, self-efficacy, and beliefs about assessing and treating written language among speech-language pathologists (SLPs) working with school-aged clients (aged 5-21 years) in school and nonschool settings in the United States. METHOD: A survey was completed by a nationwide sample of 344 SLPs working with school-aged clients in the United States. Statistical analyses were conducted to determine differences between (a) SLPs' self-efficacy in assessing and treating spoken versus written language and (b) school-based and non-school-based SLPs' clinical practice, self-efficacy, and beliefs about their roles with written language. RESULTS: All respondents reported significantly lower rates of self-efficacy in assessing and treating written language compared to spoken language, and their self-efficacy had a significant, positive relationship with the amount of clinical time devoted to written language. School-based SLPs devoted a significantly lower percentage of clinical time to written language, had significantly lower self-efficacy in addressing written language, and had lower rates of agreement on statements about their roles and responsibilities with written language compared to non-school-based SLPs. These differences were not found with spoken language. The most prevalent written language needs on respondents' workloads were reported as written expression (69.3%) and reading comprehension (66%). CONCLUSIONS: School-based and non-school-based SLPs report different levels of clinical time devoted to written language, self-efficacy in addressing written language, and beliefs about their roles in addressing written language. There is a need to investigate the reasons for these differences and the potential impact of preservice and in-service training in ameliorating them. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25511047.

Learning about Literacy: Speech-Language Pathologists' Pre-Service and In-Service Training Experiences in the United States.

To better understand speech-language pathologists' (SLPs') pre-service and in-service training experiences in literacy and the relationship between their literacy training experiences and current practice, self-efficacy, and beliefs regarding their roles in literacy assessment and treatment, a web-based survey of SLPs was conducted (n = 444). Responses revealed that 60% of respondents completed at least one literacy course in their graduate programs: 55% took courses that embedded content in literacy assessment or treatment, and 23% took courses dedicated to literacy. These results varied based on the decade of graduation. Although 73.5% of respondents felt that their graduate programs trained them well or very well to assess and treat spoken language, only 8.5% felt the same about literacy. Most respondents (80%) reported completing in-service literacy training, and 89% reported wanting more literacy training. Completion of in-service training was positively, significantly related to respondents' current literacy-related clinical practice, self-efficacy, and beliefs regarding their roles; however, pre-service literacy training was not significantly related to any of these. Though in-service training appears to play a role in helping SLPs deliver literacy services, more emphasis on increasing the quantity and quality of pre-service and in-service training in the assessment and treatment of literacy is needed.

Simplified COVID-19 guidance for adults with intellectual and developmental disabilities.

BACKGROUND: During the COVID-19 pandemic, the United States' Centers for Disease Control and Prevention (CDC) created guidance documents that were too complex to be read and understood by the majority of adults with intellectual and developmental disabilities who often read at or below a third-grade reading level. This study explored the extent to which these adults could read and understand CDC documents simplified using Minimised Text Complexity Guidelines. METHOD: This study involved 20 participants, 18-48 years of age. Participants read texts and responded to multiple-choice items and open-ended questions to gather information about how they interacted with and understood the texts. RESULTS: The results provide initial evidence that the Minimised Text Complexity Guidelines resulted in texts that participants could read and understand. CONCLUSION: Implications for increasing the accessibility of public health information so that it can be read and understood by adults with extremely low literacy skills are discussed.

Still having his say: David Yoder's legacy in AAC.

On February 2 2023, one of the guiding lights in the field of augmentative and alternative communication (AAC) for more than four decades, David E. Yoder, passed away at the age of 90. A voracious reader and gifted storyteller, David was particularly fond of a quote from George Bernard Shaw's Back to Methuselah, "You see things; and you say 'Why?' but I dream things that never were; and I say 'Why not?'" That vision led him to take on multiple leadership roles and influence the field of AAC in multiple ways. He played a pivotal role in establishing both the International Society for Augmentative and Alternative Communication (ISAAC) and the United States Society for Augmentative and Alternative Communication (USSAAC). Additionally, he chaired the panel for the National Institute on Disability and Rehabilitation Research (NIDRR)'s inaugural Consensus Validation Conference on AAC, advocated for the American Speech-Language-Hearing Association to recognize AAC within the profession's scope of practice, and served as the first editor for the Augmentative and Alternative Communication journal. In this tribute, we describe David's diverse and unique contributions to improving the lives of people with communication challenges with a focus on some of his central insights and actions.

Teletherapy, AAC & COVID-19: the experiences of speech language pathologists providing teletherapy during a global pandemic.

The COVID-19 pandemic required many speech-language pathologists (SLPs) to transition to teletherapy service delivery. This study was designed to explore the experiences and perceptions of SLPs who made this transition with children with disabilities who used aided augmentative and alternative communication (AAC). Semi-structured interviews were conducted virtually with 10 SLPs who provided regular teletherapy services to children who used AAC during but not before the pandemic. Interview transcripts were analyzed thematically using immersion, reduction, and constant comparison to understand SLP experiences and perceptions individually and across the group. Results reveal that despite the challenges faced transitioning to teletherapy, there were benefits. Furthermore, many of the participating SLPs developed successful strategies and solutions for the challenges they faced. Participants in this study highlighted the unique and important role that caregivers and parents played in the success of the teletherapy they provided. This study suggests that SLPs, caregivers, and children demonstrated resilience in the face of a large-scale, unforeseen change. SLPs consistently reported the ability to maintain continuity of care during a stressful transition period, while meeting the unique needs of the children who used AAC they served.

Sensory Experiences and Children With Severe Disabilities: Impacts on Learning.

The human sensory system is continuously engaged in experiencing and interpreting every interaction with other living beings, objects, and the environment. The purpose of this article is to describe the impact limited opportunities for rich sensory experiences have on students with severe disabilities in two middle school classrooms situated in a public separate school in the southeastern USA. The study employed a postcritical ethnographic approach and grounded theory thematic analysis of fieldnotes gathered over a two-year period. Three major themes supported by the data are presented and discussed in depth. They are: (a) students are afforded limited sensory rich experiences, (b) everyday routines make students passive recipients to school, and (c) instructional approaches result in little interaction with extended periods of waiting. The implications of the findings for improved sensory experiences and possible future directions are described.

Eye-trackers, digital-libraries, and print-referencing: A single case study in CDKL5.

BACKGROUND: Providing emergent literacy intervention and assessing outcomes for children with low-incidence, complex disabilities with concomitant physical, cognitive, sensory, and communication impairments presents a significant challenge to researchers, educators, clinicians, and families alike. AIMS: This study aimed to leverage advancements in commercially available eyetracking technologies to measure visual attention to print before and after a parentmediated print referencing intervention with a child with a severe, low incidence, congenital disability. Print referencing means drawing attention to the print on the page while reading. METHODS AND PROCEDURES: The single case study investigated a mother-daughter dyad who completed the protocol using eye-gaze technology, digital children's books, and a computer configured with software for observing and recording interactions that were shipped to the family's home and set up by the mother with remote support from a researcher. OUTCOMES AND RESULTS: Results demonstrate that the eye-tracker successfully captured the participant's eye-gaze. Furthermore, mean-level shifts in frequency of fixations demonstrates changes in visual attention to print after the parent introduced the print referencing strategy during reading. CONCLUSIONS AND IMPLICATIONS: Commercially available eye-trackers and digital libraries were successfully used by the parent-child dyad to record visual attention. Furthermore, remote support from a trained researcher was sufficient to support the parent through set-up, calibration, intervention, and implementation.

A Multilinguistic Spelling Analysis of Children who are Hard of Hearing.

Spelling in writing samples was compared between children who are hard of hearing (HH) (n = 142) and their peers with typical hearing (TH) (n = 72) in second and fourth grade. The same analyses were then conducted comparing groups of children who are HH with different levels of aided audibility. Compared to children with TH, children who are HH produced fewer misspelled words (p = .041, d = .42) at second grade but performed similarly in fourth grade (p = .943, d = .02). Compared to peers with TH, children who are HH demonstrated similar distributions of errors in roots but some differences in the distribution of errors for affixes. Different levels of aided audibility among children who are HH were not associated with significant differences in spelling accuracy at both grades. However, second-grade children with poorer aided audibility produced significantly more phonological omissions (p = .005, r = .32) and orthographic consonant errors for monomorphemic words (p = .001, r = .37), as well as more orthographic consonant errors for and affixes (p = .015, r = .28).

A Hearing Screening Pilot Study With Students With Significant Cognitive Disabilities.

Purpose Many children with severe intellectual and developmental disabilities are at a higher risk for hearing loss than their peers who are typically developing. Unfortunately, they do not consistently participate in routine school-based hearing screenings. The current study investigated the feasibility of increasing their participation using an otoacoustic emissions protocol and documented results relative to student educational profiles. Method A total of 43 students with significant cognitive disabilities enrolled at a public school exclusively serving this population participated in the study. All but 9, who were excluded because of known hearing loss, were screened by a licensed audiologist assisted by audiology doctoral students. The protocol included otoscopy, tympanometry, distortion product otoacoustic emissions (DPOAEs), and teacher surveys. Results DPOAE screening was attempted on 33 students without previously diagnosed hearing loss and successfully completed for 26 (78.8%). Two students (4.6%) with absent otoacoustic emissions and normal tympanograms were referred for further assessment due to concerns about possible sensorineural hearing loss in one or both ears, and 10 (23.3%) had abnormal tympanograms in one or both ears. Conclusions Considering the high risk of sensorineural hearing loss for children with significant disabilities, it is important for them to be included in school hearing screenings. The results of this study demonstrate the feasibility of using DPOAEs for school-based hearing screenings with this population with an interprofessional team of licensed audiologists, educators, and speech-language pathologists. The results further suggest that students with significant disabilities and hearing loss may be unidentified and underserved. Given the complex needs of this population, an interprofessional practice model for hearing screenings and intervention services is recommended.

Investigating Instructor Talk in Novel Contexts: Widespread Use, Unexpected Categories, and an Emergent Sampling Strategy.

Instructor Talk-noncontent language used by instructors in classrooms-is a recently defined and promising variable for better understanding classroom dynamics. Having previously characterized the Instructor Talk framework within the context of a single course, we present here our results surrounding the applicability of the Instructor Talk framework to noncontent language used by instructors in novel course contexts. We analyzed Instructor Talk in eight additional biology courses in their entirety and in 61 biology courses using an emergent sampling strategy. We observed widespread use of Instructor Talk with variation in the amount and category type used. The vast majority of Instructor Talk could be characterized using the originally published Instructor Talk framework, suggesting the robustness of this framework. Additionally, a new form of Instructor Talk-Negatively Phrased Instructor Talk, language that may discourage students or distract from the learning process-was detected in these novel course contexts. Finally, the emergent sampling strategy described here may allow investigation of Instructor Talk in even larger numbers of courses across institutions and disciplines. Given its widespread use, potential influence on students in learning environments, and ability to be sampled, Instructor Talk may be a key variable to consider in future research on teaching and learning in higher education.

The most frequently used words: Comparing child-directed speech and young children's speech to inform vocabulary selection for aided input.

Transactional theories of communication development focus on the interplay among child, caregiver, and environmental variables. Typically, this interplay involves symmetry between receptive and expressive modes (i.e., speech), but is asymmetrical for children with complex communication needs who hear speech but use graphic symbols expressively. Aided input, during which a communication partner points to graphic symbols while talking, may increase symmetry, but it is challenging to determine which words to represent with graphic symbols to ensure adequate aided input is provided. In this study, secondary analysis of transcripts of 16 mothers who interacted with their children with typical development across six time points (between 9 and 15 months) revealed 267 words that comprised 80% of the 257,480 words the mothers used. This list of words that mothers used most frequently was compared to three existing lists of the expressive vocabulary used most frequently by 65 toddlers and preschoolers with typical development, indicating substantial overlap. The results suggest that there is a common set of frequently occurring words that mothers use in their daily interactions with infants and toddlers, and that these same words also comprise a significant proportion of the words most frequently used by young children. Implications for representing these frequently occurring words with graphic symbols on the communication systems of children with complex communication needs are discussed.

A multilinguistic analysis of spelling among children with cochlear implants.

This study examines the spelling of nine elementary school children with cochlear implants (CIs) who use spoken language, and compares their performance with children who have typical hearing and children who are hard of hearing (HH). Compared to children with typical hearing, children with CIs did not produce a significantly different percentage of misspelled words (p = 0.431, d = 0.38), but their spelling errors comprised significantly lower percentages of homophone substitutions (p = 0.019, r = 0.61) and legal vowel errors (p = 0.011, r = 0.61). Children with CIs and children who are HH did not produce a significantly different percentage of misspelled words (p = 0.521, d = 0.31) or a significantly different distribution of categorical spelling errors. Results suggest that children with CIs utilize similar linguistic strategies as their peers who are HH but different strategies than peers with typical hearing when attempting to spell unfamiliar words.

Optimizing Home Oxygen Therapy. An Official American Thoracic Society Workshop Report.

More than 1.5 million adults in the United States use supplemental oxygen for a variety of respiratory disorders to improve their quality of life and prolong survival. This document describes recommendations from a multidisciplinary workshop convened at the ATS International Conference in 2017 with the goal of optimizing home oxygen therapy for adults. Ideal supplemental oxygen therapy is patient-specific, provided by a qualified clinician, includes an individualized prescription and therapeutic education program, and offers oxygen systems that are safe, promote mobility, and treat hypoxemia. Recently, patients and clinicians report a growing number of problems with home oxygen in the United States. Oxygen users experience significant functional, mechanical, and financial problems and a lack of education related to their oxygen equipment-problems that impact their quality of life. Health care providers report a lack of readily accessible resources needed to prescribe oxygen systems correctly and efficiently. Patients with certain lung diseases are affected more than others because of physically unmanageable or inadequate portable systems. Analysis is needed to quantify the unintended impact that the Centers for Medicare and Medicaid Services Competitive Bidding Program has had on patients receiving supplemental oxygen from durable medical equipment providers. Studies using effectiveness and implementation research designs are needed to develop and evaluate new models for patient education, identify effective ways for stakeholders to interface, determine the economic benefit of having respiratory therapists perform in-home education and follow-up testing, and collaborate with technology companies to improve portable oxygen devices. Generation of additional evidence of the benefit of supplemental oxygen across the spectrum of advanced lung diseases and the development of clinical practice guidelines should both be prioritized.

Wh - Question answering in children with intellectual disability.

This study investigated the ability of students with intellectual disability (ID) (n = 39) to answer questions beginning with different wh- question words presented in two referential conditions (i.e., with and without a picture). It also investigated participants' ability to answer questions that were more concrete (i.e., who, what, where) or abstract (i.e., when, why, how). Across conditions, the rank ordering of correct responses for each question word was: what, who, where, how, why, when. Logistic regression analysis revealed no overall statistical significance between the probability of answering questions correctly across referential conditions. Participants answered 89% of concrete and 56% of abstract questions correctly across both referential conditions, and logistic regression analysis revealed a statistically significant difference between the probability of answering concrete and abstract questions. The results of this study point to the importance of learning more about ways to support students with ID with answering wh- questions.

A Multilinguistic Approach to Evaluating Student Spelling in Writing Samples.

Purpose: Spelling is a critical component of literacy and language arts that can negatively influence other aspects of written composition. This clinical focus article describes a spelling error classification system that can be used to identify underlying linguistic deficits that contribute to students' spelling errors. The system is designed to take advantage of the linguistic expertise of speech-language pathologists to efficiently assess student errors in written compositions that are generated as a component of everyday classroom instruction. Method: A review of the literature was conducted regarding spelling as a component of literacy and language arts, the development of spelling, and the linguistic contributions to spelling. Then, existing criterion-referenced measures of spelling simple and morphologically complex words were reviewed, and a new, manual technique for analyzing spelling in student written compositions was created. Conclusions: The language expertise of speech-language pathologists enables them to readily evaluate the phonological, orthographic, and morphological errors in student misspellings, in order to identify specific underlying linguistic deficits and plan targeted interventions. The error classification system provides speech-language pathologists with a tool that is both simple and time efficient and, thus, may help increase their confidence and ability in addressing the spelling needs of students.

Comprehensive Literacy Instruction, Interprofessional Collaborative Practice, and Students With Severe Disabilities.

PURPOSE: The purpose of this clinical focus article is to briefly describe comprehensive emergent and conventional literacy instruction for students with severe disabilities. Specific attention is given to interprofessional collaborative practice and the roles of team members in planning and delivering instruction. METHOD: A rationale for the delivery of comprehensive instruction that balances skill and meaning emphases is provided with reference to new college and career readiness standards, the literature on literacy acquisition for students without disabilities, and, when possible, the literature on literacy acquisition for students with severe disabilities. Specific instructional approaches are presented to demonstrate how teams can actively engage students with severe disabilities in instruction that is collaborative, participatory, and interactive. RESULTS/CONCLUSIONS: Successful provision of comprehensive literacy instruction that allows students with severe disabilities to achieve conventional literacy takes time and the efforts of a collaborative interprofessional team. Speech-language pathologists play a critical role on these teams as they ensure that students with severe disabilities have the language and communication supports they need to be successful.

Classroom sound can be used to classify teaching practices in college science courses.

Active-learning pedagogies have been repeatedly demonstrated to produce superior learning gains with large effect sizes compared with lecture-based pedagogies. Shifting large numbers of college science, technology, engineering, and mathematics (STEM) faculty to include any active learning in their teaching may retain and more effectively educate far more students than having a few faculty completely transform their teaching, but the extent to which STEM faculty are changing their teaching methods is unclear. Here, we describe the development and application of the machine-learning-derived algorithm Decibel Analysis for Research in Teaching (DART), which can analyze thousands of hours of STEM course audio recordings quickly, with minimal costs, and without need for human observers. DART analyzes the volume and variance of classroom recordings to predict the quantity of time spent on single voice (e.g., lecture), multiple voice (e.g., pair discussion), and no voice (e.g., clicker question thinking) activities. Applying DART to 1,486 recordings of class sessions from 67 courses, a total of 1,720 h of audio, revealed varied patterns of lecture (single voice) and nonlecture activity (multiple and no voice) use. We also found that there was significantly more use of multiple and no voice strategies in courses for STEM majors compared with courses for non-STEM majors, indicating that DART can be used to compare teaching strategies in different types of courses. Therefore, DART has the potential to systematically inventory the presence of active learning with ∼90% accuracy across thousands of courses in diverse settings with minimal effort.

The Profiles of Students With Significant Cognitive Disabilities and Known Hearing Loss.

The present study describes the characteristics of students in Grades 3-12 with significant cognitive disabilities (SCD) and known hearing loss. The study analyzed results of a survey of teachers of students with SCD (n = 38,367) who were slated to participate in an alternate assessment based on alternate achievement standards in 14 states in the United States. Analysis revealed similar profiles in academic achievement and symbolic language use combined with an increased incidence of additional sensory impairments among students with SCD and known hearing loss compared to their peers without known hearing loss. Results suggest that hearing loss may be underidentified and underserved among students with SCD and point to the need for improved hearing screenings and evaluations combined with services delivered by teams that follow a model of interprofessional practice.

An Official American Thoracic Society Research Statement: Implementation Science in Pulmonary, Critical Care, and Sleep Medicine.

BACKGROUND: Many advances in health care fail to reach patients. Implementation science is the study of novel approaches to mitigate this evidence-to-practice gap. METHODS: The American Thoracic Society (ATS) created a multidisciplinary ad hoc committee to develop a research statement on implementation science in pulmonary, critical care, and sleep medicine. The committee used an iterative consensus process to define implementation science and review the use of conceptual frameworks to guide implementation science for the pulmonary, critical care, and sleep community and to explore how professional medical societies such as the ATS can promote implementation science. RESULTS: The committee defined implementation science as the study of the mechanisms by which effective health care interventions are either adopted or not adopted in clinical and community settings. The committee also distinguished implementation science from the act of implementation. Ideally, implementation science should include early and continuous stakeholder involvement and the use of conceptual frameworks (i.e., models to systematize the conduct of studies and standardize the communication of findings). Multiple conceptual frameworks are available, and we suggest the selection of one or more frameworks on the basis of the specific research question and setting. Professional medical societies such as the ATS can have an important role in promoting implementation science. Recommendations for professional societies to consider include: unifying implementation science activities through a single organizational structure, linking front-line clinicians with implementation scientists, seeking collaborations to prioritize and conduct implementation science studies, supporting implementation science projects through funding opportunities, working with research funding bodies to set the research agenda in the field, collaborating with external bodies responsible for health care delivery, disseminating results of implementation science through scientific journals and conferences, and teaching the next generation about implementation science through courses and other media. CONCLUSIONS: Implementation science plays an increasingly important role in health care. Through support of implementation science, the ATS and other professional medical societies can work with other stakeholders to lead this effort.